Due to high spatial resolution and ability to create 3-dimensional reconsctruction of the vasculature multidetector computed tomography (MDCT) allows for improved, noninvasive, and accurate visualization of coronary artery anomalies . Herein we described a new type of dual left anterior descending coronary artery (LAD) anomaly in patient with single coronary artery (SCA) arising from right sinus of valsalva. A 39-year-old physician without cardiac history admitted with the complaint of atypical chest pain. Resting 12-lead electrocardiogram showed sinus rhythm with flat T waves in the lateral precordial leads. Transthoracic echocardiography showed a mild aortic regurgitation associated with normal left ventricular systolic and diastolic functions. Subsequently performed MDCT demonstrated single coronary artery arising from right coronary sinus accompanied with previously unreported type of dual left anterior descending coronary anomaly ( Fig. 1 A and B). The proximal part of LAD originated from distal circumflex artery which is extension of right coronary artery although distal LAD arose from proximal part of the SCA. Stress nuclear scintigraphy was then performed to evaluate the functional significance of coronary artery anomaly. Myocardial perfusion scintigraphy revealed inducible ischemia at anteroseptal area supplied by LAD. Then, he was discharged with the medical treatment including beta-blocker (a daily dose of 100 mg atenolol) and a daily dose of 100 mg acetylsalicylic acid. The patient has been asymptomatic at 6-month follow-up.
